Mild dilated cardiomyopathy and increased left ventricular mass predict mortality: The Prospective P2C2 HIV Multicenter Study

• Type of Material: Article
• Authors: Stacy D. Fisher, Midatlantic Cardiology Associates; Kirk Easley, Emory University; E. John Orav, Brigham and Women’s Hospital; Steven D. Colan, Children’s Hospital of Boston; Samuel Kaplan, University of California Los Angeles; Thomas J. Starc, Columbia University; J. Timothy Bricker, University of Kentucky; Wyman W. Lai, Mount Sinai School of Medicine; Douglas S. Moodie, Oschner Clinic; George Sopko, National Heart, Lung, and Blood Institute; Steven E. Lipshultz, University of Miami
• Language: English
• Date: 2005-09
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2005 Mosby, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ahj.2005.06.012
• Title of Journal or Parent Work: American Heart Journal
• Volume: 150
• Issue: 3
• Start Page: 439
• End Page: 447
• Grant/Funding Information: This work was supported by the National Heart, Lung, and Blood Institute, Bethesda, Md (N01-HR-96037, NO1-HR-96038, NO1-HR-96039, NO1-HR-96040, NO1-HR-96041, NO1-HR-96042, NO1-HR-96043), and in part by the National Institutes of Health General Clinical Research Center (Bethesda, Md) grants (RR-00188, RR-00533, RR-00071, RR-00645, RR-00865, and RR-00043).
• Keywords: Cardiology; Pediatrics
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Background: Many HIV-infected children die with cardiac abnormalities. We sought to understand the course of these HIV-associated abnormalities and their impact on all-cause mortality. Methods: We describe longitudinal changes in left ventricular (LV) structure and function and mortality in 185 children vertically infected with HIV. Serial cardiac data were obtained from 0.1 to 10 years of age. Age- or body surface area–adjusted z scores were calculated for 10 echocardiographic outcomes. Results: Median age at first echocardiogram was 2 years (range 0.2–9.4 years); median follow-up was 3.6 years (range 0–6.3 years). The 5-year cumulative incidence of congestive heart failure was 12.3%. Mean fractional shortening z scores declined from −0.65 at 1 year of age to −1.47 at 3 years of age without further decline between 3 and 10 years of age. Among children with 2 echocardiograms performed in the first year of follow-up, mild LV dysfunction (fractional shortening of <−2 SD on both echocardiograms) was present in 29 (18%) of 158 children. For these 29 children, the 5-year mortality was 55.4%. Left ventricular mass z scores were elevated at 1 year (mean z score 0.68, P < .001) and remained elevated throughout follow-up. In the 8 children with LV mass z score of >2 SD on both initial and follow-up echocardiograms, the 5-year mortality was 75%. Conclusion: In HIV-infected children, LV structure and function progressively deteriorated in the first 3 years of life, resulting in subsequent persistent mild LV dysfunction and increased LV mass. Chronic mild depression of LV function and elevated LV mass were associated with higher all-cause mortality.